Improving pharmaceutical service delivery at provincial primary health care clinics in the Ethekwini south sub-district.
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The Department of Health adopted the District Health System as a means to unify South Africa's fragmented health services into a comprehensive, integrated National Health System (NHS). The Primary Health Care (PHC) approach is the driving force in promoting equity and accessibility to essential PHC services. Successful implementation of the PHC approach is in part, dependent on the availability of essential drugs, which impacts on patient quality of care and well-being. According to a report compiled by Pillay, McCoy and Asia in 2001 , the pharmaceutical component of the health sector reflected deficiencies in terms of the lack of equity in access to essential drugs, irrational use of drugs, poor security and cost-ineffective procurement and logistic practices. This study utilised a case study approach to examine the suitability, acceptability and feasibility of implementing a Public-Private Partnership (PPP) between the KwaZulu-Natal Department of Health (KZNDOH) the private provider, to improve pharmaceutical service delivery at provincial PHC clinics in the Ethekwini South Sub-District (ESSD). Participative observations and semistructured interviews conducted at PHC clinics in the target area provided valuable insight into problems of drug management supply, adherence to effective and rational prescribing and dispensing practices and additional training needs of the nurses. This study found the proposed PPP complementary to the mission and objectives of the Provincial DOH and suitable within the socio-political environment, in which the private provider operates. Recommendations were made to improve upon weaknesses inherent in the value chain and address deficient resources, capabilities and competences necessary to attain the PPP's critical success factors. The implementation of the proposed PPP rests on the ability of the private provider, to prove to the Provincial DOH and the National Treasury that the PPP is affordable, represents value for money and is in keeping with the goals of the NHS. Therefore, recommendations for management of these and other key stakeholders were made. On completion of all necessary modifications to the proposed model, the revised PPP to improve pharmaceutical service delivery at PHC clinics in the ESSD was found to be suitable, acceptable and feasible to both the KZN DOH and the private provider.